Your Digest for Wednesday, Dec 27, 2023 04:59 PM


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[!TIP] Patient (esp. Female) with abdominal pain + neuropsychiatric features -> need to consider acute porphyria.


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Sezary syndrome


    1. Overnight 1mg dexamethasone suppression test

Psoriatic arthritis is associated with HLA-B27.

Imaging

Psoriatic arthritis Vs. Rheumatoid arthritis

Differentiation is clinically important because prognosis and management are different.

PsA RA
better prognosis Somewhat worse
Early disease -> NSAIDS DMARDs started early
Dactylitis, enthesistis, tenosynovitis -
pattern: asymmetric oligo / symmetric, DIP is specific Symmetric polyarthritis of PIP / MCP
Sacroiliitis -
Nail changes -
- proximal hand and foot involvement (?wrist and ankles)
Source

Summary of enzymes involved

HMG-CoA reductase: Rate limiting enzyme in cholesterol sythesis : found in the liver and ? other tissues
LCAT : the enzyme synthesized by the liver and attached to HDL which exterifies cholesterol so that it becomes trapped inside HDL. Required for reverse transport of cholesterol.
LPL: lipoprotein lipase: the enzyme found on tissues which removes lipids from VLDL and it's derivatives, increasing their density.
If there is acidosis (pH < 7.2 or HCO3 < 15) or high ketonemia, manage as DKA.
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+ it is **non pruritic**, starts on the abdomen and **spreads *outwards***. (Spares palms and soles) 

Trombiculid mite = 'harvest' mite

Endemic typhus serves as the prototype for pathogenesis:
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[!INFO] DCT physiology

Inheritance: #autosomal-Recessive

These changes (except the lack of hyponatremia) are very similar to changes caused by chronic thiazide use.


8. Endocrine: reduced testosterone (due to Leydig cell dysfunction) [Source](https://emedicine.medscape.com/article/120858-overview)

Dermatologic condition Associated
Hyperkeratotic and proliferative dermatoses -
[[2022 General Medicine Paper-May#Acanthosis nigricans]]
Florid cutaneous papillomatosis (rapid eruption of warts) Stomach cancer
Sign of Leser-Trelat (rapid appearance of seborrheic keratoses) Gastrointestinal adenocarcinoma AND many others
Tripe palm (velvety thickening of palmar skin) Gastric or lung cancer
Icthyosis Hodgkin's lymphoma
Palmoplantar keratoderma Associated with SQC of oesophagus = Howel-Evans Xn
Bazex Xn: psoriatic like plaques on fingers and toes (acrokeratosis paraneoplastica SQC of aerodigestive tract
Inflammatory dermatoses - erythematous or violaceous skin eruptions
Sweet syndnrome (dermal,non vasculitic neutrophil infiltration with fever + neutrophilia) Acute myeloid leukemia, lymphoma
Dermatomyositis Ovarian, breast, cervical,uterine + others
Erythroderma (usually caused by psoriasis or atopic dermatitis) Cutaneous T cell lymphoma
Erythroderma gyratum repens Bronchogenic carcinoma
Pancreatic panniculitis Pancreatic cancer
paraneoplastic pemphigus (PAMS) Non-hodgkin lymphoma, CLL
Mucous Membrane pemphigoid Unspecified but associated with malignancy
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Hyperpigmentation
Hyperpigmentation in ectopic ACTH poduction (ectopic cushing's syndrome) Small cell lung CA
( POMC produced by the tumour is a precursor of ACTH and MSH )
Generalized dermal melanosis Extensive metastatic melanoma
Skin manifestations of amyloidosis [[2022-November#Amyloidosis]] plasma cell dyscrasias such as multiple myeloma, and less frequently, Waldenström macroglobulinemia


Interface hepatitis is seen, just like autoimmune hepatitis.
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🔖Extrahepatic manifestations of hepatitis B



Symptoms : N/V, headache,
motor effects: nystagmus, tremor, cerebellar ataxia.

Phenytoin side effects

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Despite prominent anticholinergic toxicity in some, physostigmine is contraindicated (incr. risk of arrest)

Antipsychotic drugs

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Causes of hyperprolactinaemia

#2023GM-NOV/Q30
Pathological causes

Drugs: